Dexamethasone in Hospitalized Patients with Covid-19

New England Journal of Medicine, Journal Year: 2020, Volume and Issue: 384(8), P. 693 - 704

Published: July 17, 2020

BackgroundCoronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated injury and thereby reduce progression to respiratory failure death.MethodsIn this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized Covid-19, we randomly assigned receive oral or intravenous dexamethasone (at dose 6 mg once daily) for up 10 days usual care alone. The primary outcome was 28-day mortality. Here, report the final results assessment.ResultsA total 2104 4321 care. Overall, 482 (22.9%) group 1110 (25.7%) died within 28 after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 0.93; P<0.001). proportional absolute between-group differences mortality varied considerably according level support that receiving at time randomization. In group, incidence death lower than among invasive mechanical ventilation (29.3% vs. 41.4%; 0.64; CI, 0.51 0.81) those oxygen without (23.3% 26.2%; 0.82; 0.72 0.94) but not no (17.8% 14.0%; 1.19; 0.92 1.55).ConclusionsIn use resulted either alone support. (Funded by Medical Research Council National Institute Health others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN 50189673.) Quick Take Dexamethasone Covid-19 2m 20s

Language: Английский

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Drug treatments for covid-19: living systematic review and network meta-analysis

BMJ, Journal Year: 2020, Volume and Issue: unknown, P. m2980 - m2980

Published: July 30, 2020

To compare the effects of treatments for coronavirus disease 2019 (covid-19). Living systematic review and network meta-analysis. WHO covid-19 database, a comprehensive multilingual source global literature, up to 3 December 2021 six additional Chinese databases 20 February 2021. Studies identified as 1 were included in analysis. Randomised clinical trials which people with suspected, probable, or confirmed randomised drug treatment standard care placebo. Pairs reviewers independently screened potentially eligible articles. After duplicate data abstraction, bayesian meta-analysis was conducted. Risk bias studies assessed using modification Cochrane risk 2.0 tool, certainty evidence grading recommendations assessment, development, evaluation (GRADE) approach. For each outcome, interventions classified groups from most least beneficial harmful following GRADE guidance. 463 enrolling 166 581 patients included; 267 (57.7%) 89 814 (53.9%) are new previous iteration; 265 (57.2%) evaluating at 100 events met threshold inclusion analyses. Compared care, three drugs reduced mortality mostly severe moderate certainty: systemic corticosteroids (risk difference 23 fewer per 1000 patients, 95% credible interval 40 7 fewer, certainty), interleukin-6 receptor antagonists when given (23 1000, 36 Janus kinase inhibitors (44 64 high certainty). two probably reduce hospital admission non-severe disease: nirmatrelvir/ritonavir (36 41 26 certainty) molnupiravir (19 29 5 Remdesivir may (29 6 low Only had quality reduction time symptom resolution (3.3 days 4.8 1.6 certainty); several others showed possible benefit. Several increase adverse leading discontinuation; hydroxychloroquine increases mechanical ventilation (moderate Corticosteroids, antagonists, confer other important benefits covid-19. Molnupiravir This not registered. The protocol is publicly available supplementary material. article living that will be updated reflect emerging evidence. Updates occur years date original publication. fifth version published on 30 July 2020 (BMJ 2020;370:m2980), versions can found supplements. When citing this paper please consider adding number access clarity.

Language: Английский

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Pandemics Throughout History

Frontiers in Microbiology, Journal Year: 2021, Volume and Issue: 11

Published: Jan. 15, 2021

The emergence and spread of infectious diseases with pandemic potential occurred regularly throughout history. Major pandemics epidemics such as plague, cholera, flu, severe acute respiratory syndrome coronavirus (SARS-CoV) Middle East (MERS-CoV) have already afflicted humanity. world is now facing the new disease 2019 (COVID-19) pandemic. Many leading to are caused by zoonotic pathogens that were transmitted humans due increased contacts animals through breeding, hunting global trade activities. understanding mechanisms transmission allowed establishment methods prevent control infections. During centuries, implementation public health measures isolation, quarantine border helped contain maintain structure society. In absence pharmaceutical interventions, these containment still been used nowadays COVID-19 Global surveillance programs water-borne pathogens, vector-borne spillovers at animal-human interface prime importance rapidly detect threats. Novel technologies for rapid diagnostic testing, contact tracing, drug repurposing, biomarkers severity well platforms development production vaccines needed an effective response in case pandemics.

Language: Английский

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Acceptance and attitudes toward COVID-19 vaccines: A cross-sectional study from Jordan

PLoS ONE, Journal Year: 2021, Volume and Issue: 16(4), P. e0250555 - e0250555

Published: April 23, 2021

Vaccines are effective interventions that can reduce the high burden of diseases globally. However, public vaccine hesitancy is a pressing problem for health authorities. With availability COVID-19 vaccines, little information available on acceptability and attitudes towards vaccines in Jordan. This study aimed to investigate its predictors addition these among An online, cross-sectional, self-administered questionnaire was instrumentalized survey adult participants from Jordan vaccines. Logistic regression analysis used find vaccines' acceptability. A total 3,100 completed survey. The fairly low (37.4%) Males (OR = 2.488, 95CI% 1.834-3.375, p < .001) those who took seasonal influenza 2.036, 1.306-3.174, .002) were more likely accept Similarly, believed generally safe 9.258, 6.020-14.237, willing pay 19.223, 13.665-27.042, .001), once available, above 35 years old 0.376, 0.233-0.607, employed 0.542, 0.405-0.725, less Moreover, there conspiracy behind 0.502, 0.356-0.709, do not trust any source 0.271, 0.183-0.400, have acceptance them. most trusted sources healthcare providers. Systematic required by authorities levels improve their acceptance. We believe results specifically rate alarming Jordanian should stir further studies root causes need awareness campaigns. These take form reviving national structured campaigns offer transparent about safety efficacy technology utilized production.

Language: Английский

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Therapeutic strategies for COVID-19: progress and lessons learned

Nature Reviews Drug Discovery, Journal Year: 2023, Volume and Issue: 22(6), P. 449 - 475

Published: April 19, 2023

Language: Английский

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Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia

New England Journal of Medicine, Journal Year: 2021, Volume and Issue: 385(5), P. 406 - 415

Published: June 16, 2021

BackgroundThe efficacy and safety of tofacitinib, a Janus kinase inhibitor, in patients who are hospitalized with coronavirus disease 2019 (Covid-19) pneumonia unclear.MethodsWe randomly assigned, 1:1 ratio, adults Covid-19 to receive either tofacitinib at dose 10 mg or placebo twice daily for up 14 days until hospital discharge. The primary outcome was the occurrence death respiratory failure through day 28 as assessed use an eight-level ordinal scale (with scores ranging from 1 8 higher indicating worse condition). All-cause mortality were also assessed.Download PDF Research Summary.ResultsA total 289 underwent randomization 15 sites Brazil. Overall, 89.3% received glucocorticoids during hospitalization. cumulative incidence 18.1% group 29.0% (risk 0.63; 95% confidence interval [CI], 0.41 0.97; P=0.04). Death any cause occurred 2.8% 5.5% those (hazard 0.49; CI, 0.15 1.63). proportional odds having score on compared placebo, 0.60 (95% 0.36 1.00) 0.54 0.27 1.06) 28. Serious adverse events 20 (14.1%) 17 (12.0%) group.ConclusionsAmong pneumonia, led lower risk than placebo. (Funded by Pfizer; STOP-COVID ClinicalTrials.gov number, NCT04469114.) Quick Take Tofacitinib Severe Pneumonia 2m 3s

Language: Английский

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Effect of tocilizumab on clinical outcomes at 15 days in patients with severe or critical coronavirus disease 2019: randomised controlled trial

BMJ, Journal Year: 2021, Volume and Issue: unknown, P. n84 - n84

Published: Jan. 20, 2021

Abstract Objective To determine whether tocilizumab improves clinical outcomes for patients with severe or critical coronavirus disease 2019 (covid-19). Design Randomised, open label trial. Setting Nine hospitals in Brazil, 8 May to 17 July 2020. Participants Adults confirmed covid-19 who were receiving supplemental oxygen mechanical ventilation and had abnormal levels of at least two serum biomarkers (C reactive protein, D dimer, lactate dehydrogenase, ferritin). The data monitoring committee recommended stopping the trial early, after 129 been enrolled, because an increased number deaths 15 days group. Interventions Tocilizumab (single intravenous infusion mg/kg) plus standard care (n=65) versus alone (n=64). Main outcome measure primary outcome, status measured using a seven level ordinal scale, was analysed as composite death assumption odds proportionality not met. Results A total enrolled (mean age 57 (SD 14) years; 68% men) all completed follow-up. All group received tocilizumab. 18 65 (28%) 13 64 (20%) died day (odds ratio 1.54, 95% confidence interval 0.66 3.66; P=0.32). Death occurred 11 (17%) compared 2 (3%) 6.42, 1.59 43.2). Adverse events reported 29 67 (43%) 21 62 (34%) did receive Conclusions In covid-19, superior improving days, it might increase mortality. Trial registration ClinicalTrials.gov NCT04403685 .

Language: Английский

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Long-COVID in children and adolescents: a systematic review and meta-analyses

Scientific Reports, Journal Year: 2022, Volume and Issue: 12(1)

Published: June 23, 2022

Abstract The objective of this systematic review and meta-analyses is to estimate the prevalence long-COVID in children adolescents present full spectrum symptoms after acute COVID-19. We have used PubMed Embase identify observational studies published before February 10th, 2022 that included a minimum 30 patients with ages ranging from 0 18 years met National Institute for Healthcare Excellence (NICE) definition long-COVID, which consists both ongoing (4 12 weeks) post-COVID-19 (≥ symptoms. Random-effects were performed using MetaXL software pooled 95% confidence interval (CI). Heterogeneity was assessed I 2 statistics. Preferred Reporting Items Systematic Reviewers Meta-analysis (PRISMA) reporting guideline followed (registration PROSPERO CRD42021275408). literature search yielded 8373 publications, 21 inclusion criteria, total 80,071 included. 25.24%, most prevalent clinical manifestations mood (16.50%), fatigue (9.66%), sleep disorders (8.42%). Children infected by SARS-CoV-2 had higher risk persistent dyspnea, anosmia/ageusia, and/or fever compared controls. Limitations analyzed include lack standardized definitions, recall, selection, misclassification, nonresponse loss follow-up, high level heterogeneity.

Language: Английский

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Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update

Critical Care Medicine, Journal Year: 2021, Volume and Issue: 49(3), P. e219 - e234

Published: Jan. 28, 2021

BACKGROUND: The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model provide guidance on management of patients with severe or critical in ICU. METHODS: Surviving Sepsis Campaign Coronavirus Disease panel has expanded include 43 experts from 14 countries; all members completed an electronic conflict-of-interest disclosure form. In this update, addressed nine questions relevant managing We used World Health Organization’s definition and 2019. systematic reviews team searched literature for evidence, aiming identify clinical trials. When appropriate, performed random-effects meta-analysis summarize treatment effects. assessed quality using Grading Recommendations, Assessment, Development, Evaluation approach, then evidence-to-decision framework generate recommendations based balance between benefit harm, resource cost implications, equity, feasibility. RESULTS: Diease issued statements (three new six updated) related ICU For 2019, strongly recommends systemic corticosteroids venous thromboprophylaxis but against hydroxychloroquine. addition, suggests dexamethasone (compared other corticosteroids) convalescent plasma therapeutic anticoagulation outside remdesivir nonventilated starting Because insufficient did not issue recommendation use awake prone positioning. CONCLUSION: several guide healthcare professionals caring adults Based will be updated as becomes available.

Language: Английский

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Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

The Lancet, Journal Year: 2022, Volume and Issue: 401(10373), P. 281 - 293

Published: Dec. 22, 2022

Language: Английский

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